Impact of perioperative acute kidney injury on future renal outcomes in patients who undergo radical cystectomy: A multi-institutional retrospective cohort study.

Abstract

879 Background: Acute kidney injury (AKI) is one of the frequent complications in patients who undergo radical cystectomy (RC). Although AKI has been reported to have a negative impact on renal outcomes in several diseases, the impact of perioperative AKI on major adverse kidney events (MAKE) in patients who undergo RC remains unclear. Methods: This multi-institutional retrospective cohort study included 702 patients with muscle invasive bladder cancer who underwent RC. AKI was defined according to the KDIGO criteria. Patients were divided into two groups: patients who developed AKI after RC (AKI group) and patients who did not (non-AKI group). MAKE was a composite of sustained ≥50% decline in eGFR, doubling of serum creatinine from the baseline, and sustained decrease in eGFR to <15 ml/min/1.73m 2 . The laterality and grade of hydronephrosis at the time of MAKE onset or last follow-up were evaluated. Multivariable Cox-proportional hazards regression analysis was performed to evaluate the impact of perioperative AKI on MAKE-free survival. Results: The median age and follow-up period were 70 years and 48 months, respectively. Of the 702 patients, 368 (52%) developed AKI after RC, with 26% having severe AKI (stage 2-3). Significant declines in eGFR at one-, three, and five-year after RC were observed in the AKI group compared with those in the non-AKI group ( P <0.001, P <0.001, and P <0.001, respectively). MAKE-free survival in the AKI group was significantly shorter than that in the non-AKI group ( P <0.001). After adjustment for confounding variables, including age, comorbidity, preoperative renal function, and hydronephrosis, AKI was independently and significantly associated with shorter MAKE-free survival (Table). Conclusions: Perioperative AKI had a negative impact on future renal outcomes in patients who underwent RC. Multivariable analysis for MAKE-free survival. Factor P value Hazard ratio 95% CI Age Continuous 0.730 1.005 0.978–1.033 Body mass index Continuous 0.051 1.068 1.000–1.142 Hypertension Presence 0.454 1.182 0.762–1.834 Dyslipidemia Presence 0.187 1.397 0.850–2.296 Diabetes mellitus Presence 0.370 1.257 0.762–2.072 Preoperative eGFR Continuous 0.146 0.990 0.977–1.003 Grade of hydronephrosis Continuous <0.001 1.509 1.206–1.888 Laterality of hydronephrosis Bilateral 0.301 0.734 0.409–1.318 AKI Positive 0.003 1.932 1.254–2.977